Epidemiology of Brain Disorders

Ezra Susser, M.D., Dr.P.H., Chief of Psychiatric Research
Alan Brown, M.D., Psychiatrist Research II
Michaeline Bresnahan, Dr.PH., Research Scientist II
Pamela Collins, M.D., M.P.H., Psychiatrist Research II
Daniel Herman, D.S.W., Research Scientist IV
Jennie Kline, Ph.D., Research Scientist VI
Richard Neugebauer, Ph.D., Research Scientist V
Daniel Pilowsky, M.D., Ph.D., Staff Psychiatrist
Ramin Mojtabai, Research Scientist III

The primary goal of the Department is to study the causes, course, and prevention of psychiatric disorders and their consequences in the community. The work being conducted is wide-ranging and includes birth cohort studies of prenatal risk factors in schizophrenia, prevention of HIV and homelessness in the severely mentally ill, psychiatric services research, interpersonal counseling for depression, and reproductive epidemiology. The Department also plays a very active and vital role with regard to the consequences to the community of the September 11 World Trade Center attack. All investigators in the department have extensive experience in several facets of both psychiatry and epidemiology, and many hold joint appointments at the New York State Psychiatric Institute, the College of Physicians and Surgeons of Columbia University, and the Mailman School of Public Health of Columbia University. The activities of the Department interface extensively with other departments and centers at Columbia University, including the Division of Epidemiology at the Mailman School of Public Health (headed by Ezra Susser), the Sergievsky Center, and the Lieber Center for Schizophrenia Research. The work is conducted in a wide array of geographic regions, including inner city New York, Oakland, CA, Argentina, and South Africa.

Ezra Susser, Head of the Department, has developed a program of research in prenatal origins of neurodevelopmental disorders. His other studies include the care of individuals with schizophrenia in the community, HIV epidemiology, and the development of methods in psychiatric epidemiology. This year he initiated a program of epidemiologic research to document the impact of September 11 on the mental health of New Yorkers, and the consequent needs for mental health services.

Alan Brown is Deputy Director of the Department. He holds two R01 grants from the National Institute of Mental Health. The first examines the relationship of early developmental insults to structural and functional brain abnormalities in schizophrenia among members of a large birth cohort. The second examines the relation between prenatal influenza and cytokines and risk of schizophrenia. He is also completing work on an Independent Investigator Award funded by the National Alliance for Research on Schizophrenia and Depression, which includes studies on the effect of gestational fatty acid deficiency on schizophrenia risk. Furthermore, he is conducting studies examining the role of prenatal exposure to toxoplasmosis, herpes virus infection, folic acid and retinoid deficiency, and advanced paternal age as potential risk factors for schizophrenia.

Michaeline Bresnahan focuses on the epidemiology of schizophrenia and autism. In her work on schizophrenia, she is investigating the effects of social class and ethnicity on risk of this disorder. She is also working on a study of autism in a large birth cohort in Norway and on a large collaborative study on early determinants of neuropsychiatric and other health outcomes.

Pamela Collins is funded by a K01 award from NIMH and by a Robert Wood Johnson Award for her studies on HIV risk reduction for women with severe mental illness. These include ethnographic studies of stigma and sexuality among severely mentally ill women, and a randomized clinical trial of a behavioral intervention for efficacy in this patient population. In one of her studies, she is working to reduce barriers to HIV testing and treatment during pregnancy in South Africa. She is also Co-Director of the Initiative for Minority Student Development, a 5-year grant aimed at increasing the number of minority students entering research training.

Daniel Herman was the lead author of a report entitled Rates and Treatment Costs of Mental Disorders Stemming from the World Trade Center Terrorist Attacks: An Initial Needs Assessment. The report was commissioned by the New York State Office of Mental Health as part of a funding request to the federal government. He also received an R01 grant from the National Institute of Mental Health to conduct a randomized trial of a psychosocial intervention designed to prevent homelessness and other adverse outcomes among patients discharged from state hospitals.

Jennie Kline and her colleagues are working to elucidate the causes of trisomy. In two recent studies, they tested the hypothesis that biologic aging, particularly in the ovary, explains the connection between advancing maternal age and trisomy. In the first study, they found that age at onset of menopause was about one year earlier in women with trisomic pregnancy losses than in women with chromosomally normal losses and births. Because menopause occurs when ovarian oocyte counts fall below a threshold number, the observation supports their hypothesis that trisomy arises as a function of the size of the ovarian oocyte pool. The observation is compatible with a role for accelerated aging in the reproductive system in the etiology of trisomy. In the second study, they are testing the hypothesis more directly by measuring biologic indicators of reproductive aging (i.e., counts of follicles in the ovary, hormone levels and X-aneuploidy in lymphocytes). The study is in the data analysis phase. The team is about to embark on a new study to examine whether or not skewed X-inactivation in the woman is a risk factor for trisomic spontaneous abortion.

Richard Neugebauer is continuing his work on the feasibility and efficacy of brief telephone administered interpersonal counseling (IPC) for depressive reactions to miscarriage/fetal death. This study represents an important beginning effort in an area of secondary prevention of depressive symptoms among women of reproductive age. He holds grants focusing on adapting IPC to an exclusively Spanish speaking, socially disadvantaged population. The NIMH award focuses on adapting IPC for English speaking patients of diverse ethnicity, social class and life style. He also wrote the lead editorial in the American Journal of Public Health marking World Health Day; the paper drew attention to the role of social factors and stigmatization in mental disorders.

Ramin Mojtabai’s research focuses on services for severe mental disorders. He is currently completing a Mentored Research Scientist Career Award (K01) from the National Institute of Mental Health which examines the extent and correlates of continuity of care in the early stages of schizophrenia and other psychotic disorders. He also collaborates with two other members of the department, Drs. Herman and Susser, on a Critical Time Intervention study which aims to improve continuity of aftercare and housing for seriously mentally ill homeless patients discharged from state hospitals. Dr. Mojtabai’s other research interest is the study of the course, impairment and treatment of major depression in the community.

Daniel Pilowsky has a career development award which aims to compare psychopathology, social functioning, and other psychosocial outcomes among children of HIV positive IDUs (Injection Drug Users) to those observed among children of HIV negative IDUs. Children of IDUs have to cope with multiple stressors and are at high risk for psychopathology. Those whose parents are HIV positive are hypothesized to be at even higher risk. He also received an R01 grant from the National Institute on Drug Abuse aimed at reducing sexual risk behavior among young adult drug users.

The Department also includes Ruth Ottman and Maureen Durkin, who work primarily in the Sergievsky Center.